FARM INSURANCE QUOTE APPLICATION FORM

****YOUR DUTY OF DISCLOSURE****
***What you NEED to tell us*** You must tell us anything that you know, or should know, that could affect our decision to insure you and/or the terms on which we insure you. You must do this when you apply for a policy, renew your policy or when you change or reinstate your policy. When we ask you specific questions, you must answer these questions truthfully and in a way that a reasonable person in the circumstances would answer them. It is important that every person who will be insured by the policy answers all questions in this way. These requirements are part of the Insurance Contracts Act 1984. You are required before you renew, vary, extend or reinstate your policy to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision to insure you, and anyone else to be insured under the policy, and if so, on what terms. What will happen if you do not tell us - penalty for non-disclosure or misrepresentation If you withhold relevant information and/or you do not answer our questions truthfully, the insurer may reduce, refuse or decline a claim completely and/or cancel your policy from inception. If your failure to tell us is fraudulent and/or your answers are untruthful, the insurer can treat your policy as if it never existed and we do not want that to happen to you.
POLICY HOLDER & PROPERTY DETAILS
ie hobby farm (nil income earned), horse riding school, cattle farm, horse agistment etc
If yes, provide an estimate of your next 12mths income amount for this property.
HOME SECTION
Please complete this section if you wish to insure your home dwelling(s) - must have certificate of occupancy
ie, brick veneer, weatherboard/timber, fibro..
ie, tiled, colourbond, concrete...
ie Concrete, timber...
ie Owner Occupied, Tenanted, Holiday Home?
ie jewellery, portable electronic equipment, sporting equipment...
If there is no Certificate of Occupancy, we will be UNABLE to provide cover.
FARM PROPERTY SECTION - Structure 1
Please complete this section if you wish to insure your farm buildings, above ground improvements and/or farm contents (excluding home contents)
ie, workshop shed, tack shed, garage shed, stables, multipurpose shed...
ie, steel, timber, brick...
ie, steel, timber, no roof...
This is for general farm tools and equipment and CANNOT include motor vehicles, trailers and other farm machinary over 100cc (section farm motor section for this)
FARM PROPERTY SECTION - Structure 2
Please complete this section if you wish to insure your farm buildings, above ground improvements and/or farm contents (excluding home contents)
ie, workshop shed, tack shed, garage shed, stables, multipurpose shed...
ie, steel, timber, brick...
ie, steel, timber, no roof...
This is for general farm tools and equipment and CANNOT include motor vehicles, trailers and other farm machinary over 100cc (section farm motor section for this)
FARM PROPERTY SECTION - Structure 3
Please complete this section if you wish to insure your farm buildings, above ground improvements and/or farm contents (excluding home contents)
ie, workshop shed, tack shed, garage shed, stables, multipurpose shed...
ie, steel, timber, brick...
ie, steel, timber, no roof...
This is for general farm tools and equipment and CANNOT include motor vehicles, trailers and other farm machinary over 100cc (section farm motor section for this)
FARM PROPERTY SECTION - Structure 4
Please complete this section if you wish to insure your farm buildings, above ground improvements and/or farm contents (excluding home contents)
ie, workshop shed, tack shed, garage shed, stables, multipurpose shed...
ie, steel, timber, brick...
ie, steel, timber, no roof...
This is for general farm tools and equipment and CANNOT include motor vehicles, trailers and other farm machinary over 100cc (section farm motor section for this)
FARM PROPERTY SECTION - OTHER ITEMS
Please complete this section if you wish to insure ANY above ground improvements such as fencing and/or hay/livestock
Please advise what type of livestock, a cost per head and how many livestock.
Depending on your specific farm activities, this Section of cover may or may not be available. This will be reviewed by our specialist.
Please outline a name, year built and sum insured for ANY registered & unregistered farm machinery (ie rideon mower, tractors), motor vehicles, quad bikes here.
You must answer accurately and truthfully, otherwise this may affect your ability to claim.
You must answer accurately and truthfully, otherwise this may affect your ability to claim.
If you require cover for any other sections that are available under Farm pack insurance, please advise here. • Personal Accident and Illness? • Land transit? • Pleasurecraft/Boat? • Machinery Breakdown? • Computer/electronic equipment breakdown? • Theft of farm contents? • Working dogs? • Tax Audit? • General Property for portable non domestic contents outside of the property?